Good News For Organ Transplants

Hawaii patients waiting for organ transplants are very, very lucky. Thanks to The Queen’s Medical Center, with help from the Kidney Foundation of Hawaii and the state Legislature, we will continue to have a transplant program in our state.

The situation was precarious for quite a while. Hawaii Medical Center, which housed the only transplant program in the state, was struggling to survive. Its shaky financial situation forced the transplant operation to move three times in five years. Most of the people in the program understood an eventual shutdown was inevitable.

Dr. Whitney Limm (who was my surgeon when I donated a kidney to my dad in 2006) says Queen’s made it clear early on it was willing to help. But the timing had to be right.

“There was this bankruptcy proceeding and Queen’s did not want to interfere, so it stayed in the background. But the board of trustees at Queen’s did vote to spend $7 million to $8 million in a five-year period to bring the program to Queen’s.

“So in December, on a Friday, HMC said, OK, we’re shutting down. It was very abrupt. Immediately nurses started notifying the patients on the list that the program was shutting down and that they should come to get their medical records.

“At the same time the people at Queen’s started the application for getting the transplant license from UNOS (United Network for Organ Sharing). And this was right before Christmas.”

According to Limm, the team at Queen’s worked late into the night tackling an almost overwhelming amount of paperwork, requesting permission to handle liver, kidney, pancreas and heart transplants. UNOS, knowing the dire and special situation of patients in Hawaii, is supportive and “they’re trying to make it quick. And we heard that they’ll probably give a favorable ruling in early February for liver transplants, and then for kidney transplants later in the month.”

The decision to OK the liver program first makes sense, even though kidney patients far outnumber those waiting for livers. Says Limm: “Liver transplants are lifesaving. There’s no dialysis for it, so it’s more critical.”

And critical is exactly the right word to describe what it would be like for patients without a local transplant program.

“When you donated to your dad, he was on the waitlist for a cadaver kidney while you were being evaluated,” says Limm. “The people in Hawaii who are on the current list are on a waitlist that’s inactive. Hawaii doesn’t have an active transplant program, so they’re on a list that isn’t getting them anywhere.”

Donors and recipients would have to go to the Mainland for surgery and follow-up, placing a tremendous burden on them and their families.

The Kidney Foundation, according to Limm, also saw what was coming and was working independently to keep the program alive. It urged the Legislature to provide funding to help get a new transplant center off the ground. Last week a legislative conference committee advanced a bill that will give $1.5 million to help fund the liver and kidney transplant program at Queen’s.

Every dollar from both Queen’s and the state will be needed. Queen’s already has hired close to 20 people from the HMC program. They include nurses, transplant coordinators, social workers, financial advisers, pharmacists and staff members.

And there will be a lot of training involved for the existing staff at Queen’s. According to Limm, “almost every department in the hospital is involved in the care of the transplant patient,” from admitting to ER and intensive care, to the laboratories, pathology and surgery departments. The electronic records system has to be tweaked. Also, Queen’s is renovating a floor to include a new transplant clinic for evaluations and follow-ups.

All of this will take not only money, but time. It’ll be months before the program is up and running. According to Limm, the state acted quickly and has already granted a Certificate of Need. But UNOS will be issuing licenses organ by organ over a period of weeks or months. And finally, the program must win approval from the Centers for Medicare and Medicaid Services.

Limm, who will do double duty as Queen’s vice president of Clinical Integration and medical director of the Kidney Transplant Program, is looking forward to a busy and challenging year. “I’m feeling very thankful that Queen’s and the Legislature have offered that kind of support.”

I’m grateful, too. And so are hundreds of people in Hawaii anxiously awaiting an operation that can improve or save their lives.